Hi, I’m Mike Reeves-McMillan, Registered Hypnotherapist (NZ) and health coach. I help a lot of people who want to stop smoking, and the material in this ebook is based on what I tell them in my face-to-face sessions.
Of course, information by itself isn’t going to enable you to stop smoking. You already have plenty of information about the health effects of smoking (it’s written on the packets in most countries, after all). Yet you haven’t stopped yet. Why not?
There are a few reasons, and I’ll talk about them and address them as we go through this ebook. More importantly, though, I’ll give you tools, tips and techniques which, if you apply them and stick with it, can make the difference you need to quit tobacco and overcome your cigarette smoking habit. Information about smoking and its effects and the benefits of giving up smoking is important, but motivation to quit smoking, tips for giving up smoking and strategies to stop
smoking are vital if you’re going to succeed.This ebook is part of an online course I created called Smokefree Life. The ebook is free, and you can distribute it however you like as long as you don’t change it in any way or charge for it. The course costs a small amount of money, about the same as a couple of packs of cigarettes, and gives you a whole stack of extra resources to make giving up smoking easier. The Resources section at the back tells you what they are.
Smoking isn’t just a behaviour. It’s a set of thoughts, feelings and behaviours that cluster together and support each other. Part of what we’ll be doing is challenging those feelings and thoughts so that you can start to shift the behaviours.
Some people smoke as a ritual, others have a smoking habit. In both cases, it’s often a way of distracting themselves from their lives – a way that doesn’t solve any of their problems and that causes them more problems.
Some people smoke to manage their stress and emotions. But a study in the UK showed that, on average, smokers were less happy and had a poorer quality of life than nonsmokers – and this improved after they gave up. Smoking also keeps your body stressed and keyed-up – it’s a really bad way to manage stress. In fact, there is no problem so terrible that poisoning yourself is a good solution.
Finally, some people smoke because trying to quit smoking gives them distressing feelings, and they feel they can’t push past that to get all the benefits and lose all the negatives.This ebook is here to help you with that, so that you can quit smoking and not only feel good but also feel good about yourself.
Right at the start I’d like to tell you a bit about how nicotine (the addictive ingredient in tobacco) works. I find when I tell people this it helps them to shift their thinking and understand why they’ve felt the way they have and why it is that they have found it hard to change.
Nicotine is made by the tobacco plant as an insecticide – it’s how it protects itself from insects. The insects get poisoned when their nervous systems get overwhelmed. Now, humans are bigger than insects, so it takes a lot more nicotine to kill us (it is deadly in large enough quantities, but because it dissolves in water and passes out of the body very quickly, you wouldn’t be able to get that amount of nicotine from smoking.)
It does still affect human nervous systems, though. When you smoke, the smoke that you breathe in hits the damp tissue in your lungs and gets absorbed into your bloodstream along with the oxygen you breathe in. Very soon afterwards, it reaches your brain. (Most of the really harmful chemicals in cigarettes are there to help the nicotine reach your brain faster and in greater quantities.)
In your brain, nicotine is very much the same shape as a chemical that belongs there (acetylcholine, if you’re curious). That chemical slots into receptors in the brain like a key into a lock, and when it does it releases the chemical called dopamine.
Dopamine is at the root of every known addiction, because it’s the “reward” or “compulsion” chemical. Some people say, “I don’t even like cigarettes, but I still want one.” This is because the feeling of “wanting” is produced by the dopamine system.
Effectively, then, nicotine is lying to your brain and telling it that it wants cigarettes. What’s more, dopamine is involved in creating vivid memories, so you remember that wanting very clearly.That’s why people who aren’t stupid or lazy or irrational or unmotivated still find it hard to stop using a substance – nicotine – that is delivered in a way that damages their health.
Just knowing that the wanting is a false signal can help you to ignore it.
If you want to know more about how nicotine works, How Stuff Works has a really good summary.
I almost didn’t put this section in, because everyone knows that smoking is bad for you, right? But I thought I’d give a brief summary of exactly how smoking affects your body, because a lot of people aren’t really sure.
Smoking damages your skin – it’s easy to recognise a smoker by their skin. This is partly because of the direct effect of the smoke on the outside of the skin, but more because any time there are poisons or toxins in your body, your skin is affected. Your skin is your largest body organ, and anything that’s wrong with you will show up there. It’s also one of the ways poisons leave your body.
Smoking damages your lungs, obviously, since that’s how the nicotine gets into your body. (It also damages the throat and tongue on the way through.) Your lungs are very good at dealing with dust, smoke and other rubbish that you breathe in, and they have special immune mechanisms to take care of it. But if you’re stressing those mechanisms all the time, they can break down, or even turn into cancers instead.
Smoking puts strain on your liver and kidneys, which are responsible for taking poisons out of the blood (in the case of the liver) and passing them out of the body (your kidneys).Smoking damages your blood vessels and your heart. One of the effects of smoking is to boost your stress reaction (that’s why you get a sense of focus when you have a smoke). That increases your heart rate and blood pressure, thickens your blood and narrows your blood vessels. All of this, repeated over many years, can cause a lot of damage. This can lead to heart attacks or strokes (damaging your brain).
The good news is that your body is very resilient and can usually recover from most of this damage eventually, once you stop smoking. Here’s a timeline of how it recovers and the health benefits of stopping smoking (from the US Centers for Disease Control):
20 Minutes After Quitting: Your heart rate drops.12 hours After Quitting: Carbon monoxide level in your blood drops to normal. (Carbon monoxide is one of the main poisons in car exhaust. It blocks your blood cells from carrying oxygen to the rest of your body.) 2 Weeks to 3 Months After Quitting: Your heart attack risk begins to drop. Your lung function begins to improve.
1 to 9 Months After Quitting: Your coughing and shortness of breath decrease.
1 Year After Quitting: Your added risk of coronary heart disease is half that of a smoker.
5 Years After Quitting: Your stroke risk is reduced to that of a nonsmoker 5-15 years after quitting.
15 Years After Quitting: Your risk of coronary heart disease is back to that of a nonsmoker.
Even though some of these changes take a long time (good motivation to stay stopped!), one thing you will notice after you stop is that you have more energy. This is because your body isn’t having to repair itself so much and filter out so many poisons. More energy is just one of the benefits of giving up smoking.
While I’m talking about bodies, a lot of people are worried that they’ll gain weight when they stop smoking. People do sometimes gain weight after they stop, but if you understand why and have some strategies to prevent it, you can stop smoking without gaining weight.
There are three main reasons people gain weight when they quit smoking.1. The reason I mentioned in the section above – you’re no longer using so much energy just to keep your body on a relatively even keel. The proteins you used to use to repair the damage get broken down for energy instead, and your body isn’t having to strain to get rid of all the poison either. This means you don’t actually need to eat as much.
2. Your body is used to a blood sugar boost from smoking, as it throws your body into stress mode. When you don’t get the regular boost, something feels “wrong”, and you compensate by eating something sweet. (It’s not actually wrong, just different.)
3. Some people are so used to having something in their mouths that when they don’t have cigarettes there, again something feels wrong.There are several strategies you can use to quit smoking without gaining weight. Here are some suggestions: 1. Reduce the size of plate you use slightly, so you are eating less but it looks the same amount. (This really works.)
2. Eat fruit or carrot sticks. They are high in fiber, so they satisfy your stomach, and they give a slight blood sugar boost but not the big, harmful jump that a sugary snack will. They also contain vitamins and minerals to help your body repair itself from the smoking damage.
3. Chew sugar-free gum if you miss having something in your mouth.Keeping these stop-smoking benefits in mind will help you persevere in the process of giving up smoking. (Grateful acknowledgement to the US National Heart, Lung and Blood Institute, http://www.nhlbi.nih. gov).
1. Health: As mentioned above, your chances of having a heart attack, stroke, many kinds of cancer, and lung diseases start reducing when you stop smoking. You start to feel more alive (and there’s a reason for that).
2. Appearance of your skin improves. Smoking makes you look older and turns your skin wrinkled and leathery.3. Smell of your clothes, hair, breath, home, and car improves.
4. Breathlessness when climbing stairs and walking starts to go away.
5. Coughing in the morning reduces or disappears.
6. Your children will have fewer coughs, colds, and earaches and be less likely to smoke themselves.
7. Sleep is deeper and more refreshing when you don’t smoke.
8. Energy won’t be diverted to healing the damage from smoke.
9. Money is going up in smoke every day you are a smoker – think what else you could do with it!
1. Write down the things you don’t like about smoking and the benefits of giving up smoking. Carry it as a reminder.
2. Write down your excuses for smoking and then write down why they aren’t true. 3. Notice the activities you associate with smoking and write down how you will break your routine so you aren’t triggered. (More on this under How to Make a Plan.)
4. Remove all tobacco from your house, car, and wherever else you keep it. Don’t replace it or “borrow” from other people.
5. Designate smokefree areas like your car, your house etc. Increase them until the world is a smokefree area for you.
6. Imagine yourself in a few years’ time if you go on smoking – how unhealthy and unhappy you’ll be. Then imagine what you could do instead if you were smokefree. (This is one of the motivational techniques I cover in the Smokefree Life online course.)
7. Get support from friends and family to stop and stay stopped.8. Reward yourself when you don’t smoke. Your mind has been getting a false reward with each cigarette. Give yourself a real reward instead.
9. Look for better ways to deal with stress, anxiety and strong emotions. Deep breathing and exercise are good. (I’ll talk more about this later too.)
10. Get help from your doctor, public health nurse, Cancer Society or other health groups.
Over the first 1-2 weeks while your body adapts to not being poisoned, you may notice irritation, anxiety, depression, trouble concentrating, sleep difficulties, coughing, sore throat, constipation, or hunger as side effects of quitting smoking. These are also called “recovery effects”.
To deal with the side effects of giving up smoking:
1. Breathe deeply to help your lungs clean out.
2. Drink less coffee, tea and caffeinated soft drink, and more water and fruit juice. (Nicotine and caffeine interact, and when you’re not smoking caffeine will have a stronger effect on you, so cut down a little.)
3. Eat fruit between meals and at the start of meals. Also try sugar-free gum, carrots or celery sticks.
4. Move around if you feel cravings, anxiety or anger. (I’ll talk more about exercise later.)
6. Change your routine so that you don’t fall into old habits. (See below under Making a Plan.)
7. Notice what’s happening with your body, mind and emotions. Let the feelings come and then let them go. They will usually only last a few minutes. (I’ll talk more about this in the Stress Management section.)
8. Think about your reasons for stopping.
9. Talk or write about how you feel. Putting feelings into words reduces their power.
These quitting smoking side effects will pass off in time – usually between a week and a month. After that it gets easier.
Everyone who comes to me to stop smoking is in two minds about quitting. I know that, because if they only wanted to stop smoking they wouldn’t have to come, and if they didn’t want to stop smoking at all they wouldn’t come to me for help.
Ambivalence is actually a good thing. It shows that you’re thinking about both sides of the issue. If you’re closing your eyes to the benefits of change and the costs of staying the same on the one hand, or the costs of change and the benefits of staying the same on the other hand, you’re not being realistic.
But to move forward, you need to resolve your ambivalence. If you’ve bought my Smokefree Life course, you should have got access to the audio track Integration. That track uses a true story as a hook to help the inner parts of yourself that have been resisting change “get with the programme”and join in the important work of becoming smokefree.
Listen to that track now, before you read on, to increase your motivation to quit smoking.2. Reduce your barriers to change. Deal with what is preventing you from moving forward. (That’s what this whole course is about.)
3. Become clearer on the drawbacks of remaining where you are. Realise that you actually won’t remain where you are; things are going to get worse if you keep doing what you’re doing.
4. Find ways to replace the benefits of your current situation with something that will help you move into the new situation. I give you an example on the Smokefree Life track which you can get from the downloads page if you’ve signed up for the Smokefree Life online stop-smoking course.
I’ve created an exercise which combines several of these methods. I call it the Marty McFly technique, because it’s a bit like the Back to the Future movies. You can find it on the downloads page for the course.Nicotine replacement therapy (NRT) is controversial for some people. It involves giving yourself nicotine without smoking, so that it’s easier to make the transition. The nicotine is given in patches you stick on your skin, in chewing gum or lozenges, or in an inhaler. The idea is that your brain is yelling out for nicotine and it’s going to be easier to change the behavioural part of smoking if you can give it enough nicotine to shut it up a bit while you stop smoking.
You get less nicotine through NRT than you do through cigarettes. Even the large patches only give about 1mg per hour, and you can get around 7mg from a single cigarette. The patches are constant slow-release and ramp up slowly, while the gum and lozenges give you a quick “top-up”. Some people use them together, which is fine.
Although nicotine is poisonous in large doses (larger than NRT or cigarettes give you), it is generally not thought to cause cancer – it’s the other ingredients in the cigarettes that do that. Some scientists disagree and think it does contribute to cancer, but it is certainly less harmful getting it from NRT than from cigarettes.
There are philosophical arguments that oppose using nicotine in an attempt to stop being dependent on nicotine, but it can be seen as a way of cutting down while removing the toxic parts of the smoke from yourself and your environment.
Nicotine withdrawal symptoms include:
• Irritability
• Anger
• Moodiness
• Restlessness
• Tenseness
• Anxiety
• Hunger
• Weight gain
• Poor concentration
• Sleep disturbance
If you have these symptoms while on nicotine replacement therapy, the cause is not the NRT.
If you experience nausea (feeling as if you are going to throw up), faintness or headaches while on NRT, this does mean you are taking too high a dose.
Cut down until you feel OK again.
Could NRT Help You?
I give a standard test to my clients who come to me to stop smoking, to assess whether they might benefit from NRT. (In New Zealand, the government subsidises NRT, and I’m a Quit Card provider, meaning that I can give what amounts to a prescription for my client to take to any pharmacy and they only pay a small fee to get it issued. Other countries do not have this scheme. If you are in New Zealand, many practice nurses, occupational health nurses or community health workers are Quit Card providers. Ask – it might save you some money.)
The standard test is called the Fagerstrom Test of Nicotine Dependency. If your score on the Fagerstrom is very low (under 3), NRT is unlikely to help you, but if it is 3 or above, and especially if it is very high, NRT is probably a good idea for you.
Here is the test. In the Score column, write down the number of points that is next to the best answer for you, and then add them up at the end.Questions
1. How soon after you wake up do you smoke your first cigarette?
2. Do you find it hard not to smoke in places where smoking is not allowed?
3. Which cigarette would you hate most to give up?4. How many cigarettes a day do you smoke?
5. Do you smoke more often during the first hours after you wake up than during the rest of the day?
6. If you are so unwell that you are in bed most of the day, do you still smoke?
Total out of 10:Answers Points Score Within 5 minutes 3
6-30 minutes 2
31-60 minutes 1
more than 1 hour 0
Yes 1
No 0
The first one in 1
the morning
Any other one 0
Less than 10 0
11-20 1
21-30 2
More than 31 3
Yes 1
No 0
No 0
Add up your scores. If your score is 3 out of 10 or more, look into getting some nicotine replacement therapy. According to some scientific studies, it can double your chances of success if used correctly. See below for advice on using nicotine replacement products.
Using Nicotine Patches
Nicotine patches are available in different strengths.
Decide where you want to wear the patch.
Choose a clean, dry area with no body hair, avoiding creams, lotions, oils or powder.
Cut the sachet and remove the patch. Don’t cut the patches up.
Peel the backing and apply the sticky side to skin.
Press firmly for 10 seconds.
Change position each day. Wait three days before using the same area again.
Using Nicotine Gum
Nicotine gum is not used like ordinary chewing gum. When you feel the urge to smoke: 1. Chew one piece of gum until the taste becomes strong or peppery as nicotine is released. 2. Roll the gum and “park” it in your cheek.
You can repeat these steps for 30 minutes, 8-12 times per day.
As you need less nicotine you can cut the gum up and mix with ordinary chewing gum.
Using Nicotine Lozenges
Lozenges work much the same as gum, but they are prescribed for people who have difficulty chewing or for other reasons prefer them to gum.
Do not suck the lozenge continuously like a throat lozenge. Do not bite or chew it.
1. Place one lozenge in the mouth between gums and cheek.
2. Suck slowly until the taste becomes strong.
3. Stop sucking until the taste fades, then suck again.
4. Occasionally move the lozenge from one side of the mouth to the other.
Some people find the taste of the lozenges unpleasant. If you find it worse than the nicotine withdrawal symptoms, stop using the lozenges.
Warnings for Gum and Lozenges
Keep all NRT products out of reach of children, and dispose of carefully.
Don’t eat or drink for 15 minutes beforehand or while using lozenges or gum.
Nicotine can cause throat irritation and an increase in saliva at first.
Some of the following is based on the website Become an Ex. It’s a good website, and helps you make an online plan. If you’re on the computer a lot, consider signing up there. (They have an iPhone app and a mobile version as well, if you always have your smartphone with you.)
1. Track Your TriggersFor 3 days, each time you have a cigarette, pay attention to what you were doing or what was happening just before and how strongly you wanted it.
At the end of this process, you should have a clear idea of what triggers off your smoking. l Is it being in a particular place?
l Is it a feeling?
l Is it something you eat or drink?
l Is it being around someone else?
l Is it a particular activity?
The association of smoking with those triggers was a learning process. Separating them from the triggers is a learning process too.
BecomeAnEx suggests that you start by not smoking until a few minutes after you want to. Gradually extend the time. By doing this you are teaching yourself to separate the trigger from the smoking – because they really are two different things.
You may want to quit smoking right now, rather than delaying. But if delaying is going to work, and stopping suddenly isn’t, which is better?
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